What is Cytomegalovirus (CMV)?

From the Guidelines

Cytomegalovirus (CMV) is a double-stranded DNA virus in the Herpesvirus family that can cause disseminated or localized end-organ disease among patients with advanced immunosuppression, as noted in a study published in 2009 1.

Definition and Transmission

CMV spreads through bodily fluids including saliva, urine, blood, tears, semen, and breast milk. Most people with CMV never develop symptoms, but when symptoms do occur, they may include fever, fatigue, sore throat, and swollen glands.

At-Risk Groups

CMV is particularly concerning for two groups: immunocompromised individuals (such as organ transplant recipients or those with HIV/AIDS) and pregnant women, as the virus can cause serious complications including organ damage in those with weakened immunity and birth defects in developing fetuses.

Diagnosis and Treatment

Diagnosis typically involves blood tests, and treatment may include antiviral medications like ganciclovir or valganciclovir for severe cases, though most healthy individuals don't require treatment.

Prevention

Prevention measures include good hygiene practices, especially handwashing after contact with bodily fluids, and careful screening of blood and organ donations.

Recent Findings

A more recent study from 2024 1 highlights the importance of prophylaxis and pre-emptive therapy in preventing CMV infections, especially in patients undergoing allogeneic hematopoietic cell transplantation (HCT), and notes that letermovir has shown promise in reducing the incidence of CMV reactivation and disease in these patients.

Key Considerations

It's crucial to prioritize the management of CMV based on the most recent and highest quality evidence to minimize morbidity, mortality, and improve quality of life for affected individuals. Some key points to consider include:

• The use of antiviral medications like ganciclovir or valganciclovir for severe cases of CMV infection.
• The importance of prophylaxis and pre-emptive therapy in preventing CMV infections, especially in immunocompromised individuals.
• The need for careful screening of blood and organ donations to prevent the transmission of CMV.
• The potential for resistance to antiviral agents, and the need for monitoring and adjustment of treatment regimens as necessary.

From the FDA Drug Label

CMV syndrome was defined as evidence of CMV viremia accompanied with fever greater than or equal to 38°C on two or more occasions separated by at least 24 hours within a 7-day period and one or more of the following: malaise, leukopenia, atypical lymphocytosis, thrombocytopenia, and elevation of hepatic transaminases Number of patients with CMV disease = Number of patients with tissue-invasive CMV disease or CMV syndrome

Cytomegalovirus (CMV) is a virus that can cause disease, including tissue-invasive CMV disease and CMV syndrome. CMV syndrome is characterized by evidence of CMV viremia accompanied by symptoms such as fever, malaise, leukopenia, atypical lymphocytosis, thrombocytopenia, and elevation of hepatic transaminases 2.

From the Research

Definition of CMV

• Cytomegalovirus (CMV) is a herpes virus that can cause severe illness and death in people with compromised immune systems, including organ and bone marrow transplant recipients, HIV-infected individuals, and newborns infected during pregnancy 3.
• CMV is a common infection in the community, but diagnosis can be challenging, requiring careful clinical assessment and diagnostic algorithms 3.

Effects of CMV

• CMV can cause life-threatening opportunistic infections in individuals with acquired immunodeficiency syndrome (AIDS), affecting 7.4% or more of patients with AIDS 4.
• Common manifestations of severe CMV end-organ disease include retinitis, colitis, esophagitis, and gastritis 4.
• CMV retinitis is a potentially blinding manifestation of CMV infection, commonly seen in advanced AIDS patients, but also recognized in patients with immune deficiency from multiple causes 5.

Treatment and Management

• Valganciclovir, an orally administered prodrug of ganciclovir, is effective in treating CMV infection and disease in immunocompromised patients, offering improved patient compliance and reduced risk of viral resistance 6.
• Ganciclovir, a nucleoside analogue, has been shown to halt the progression of CMV retinitis and gastrointestinal disease, but requires lifelong maintenance therapy to prevent relapse 4, 7.
• Foscarnet, a pyrophosphate analogue, also appears to have efficacy in treating CMV infection, without causing myelosuppression 4.
• Treatment modalities for CMV retinitis include systemic and intravitreal antiviral medications, with retinal detachment and immune recovery uveitis requiring specific treatments 5.